pregnant women using the perimom
Louise Broadbridge
Louise Broadbridge

How to prevent tearing during birth

Experiencing some kind of tear or graze is a common result of a vaginal delivery. For most women, any perineal tear will be fairly minor and heal quickly but in some cases, it can be more serious.

The good news is that there are things you can do to help prevent tearing during birth.

What is a perineal tear?

The perineum is the name given to the muscle between your vagina and anus. When you are giving birth, this area is put under a lot of pressure and this can lead to a tear.

Tears usually happen on their own, unlike an episiotomy, which is a medical incision sometimes made to help deliver the baby.

Perineal tears are referred to as first, second, third or fourth degree, with first being fairly minor and usually heal without needing stitches to repair and a fourth degree tear being a serious birth injury, which will require surgery and follow up physiotherapy.

According to The Royal College of Obstetricians & Gynaecologists, up to 90 per cent of first-time mums will have either a graze, tear or episiotomy during a vaginal birth.  However, you’ll be pleased to know that 3rd and 4th degree amounts to less than 5% of tears.

How can I avoid a perineal tear?

Current research suggests that massaging your perineum in the final few weeks of pregnancy can make you less likely to tear while giving birth. Daily perineal massage is recommended from 34 weeks of pregnancy.

By this time you could have a sizable bump and reaching down to your perineaum might be a challenge. If you are unable to reach, you could ask a partner for help or alternatively, you can look at a massage tool like Perimom which gives you that extra bit of length for reaching around your bump.

You should be aiming to massage at least 3 to 4 times per week to prepare your perineum as much as possible.

Here are my tips for perineal massage:

1. Nails, Hands and Oil

Using your hands, make sure your nails are cut short before you start so you don’t accidentally scratch the skin, which is very delicate around the vagina and perineum.  It is a good idea to take a warm bath before you start as this will help you feel more relaxed and will ensure the area is clean and the muscles around your perineum are loosened.

2. Positioning

Get yourself into a comfortable position for the massage – your bed is likely to be the best place. Use pillows to support your back and bend your knees. Make sure you have a suitable oil handy. It is important to use a pure, 100% natural oil, ideally one formulated specifically for this delicate area of your body. I recommend Motherly Love Down Below perineal massage oil because it is designed by a midwife and uses only the best plant based ingredients for maximum nourishment to the area for greater elasticity in your perineum. You can purchase your oil here.

3. Place both thumbs in your vagina and press down towards the anus and the sides of your vagina’s walls. Hold them in this position for around a minute and breathe deeply. You should notice a stretching sensation when you do this. Massage the lower half of your vagina for two to three minutes using a u-shaped movement - from 3 o’clock position to 9 o’clock, and repeat up to three times. If you can, massage your perineum daily to make the area more elastic and prepare it for birth.

For a more detailed guide to perineal massage - download my handy guide here

What can I do during the birth to prevent a tear?

There are also things you can do during birth to help prevent a tear. The most important of these is to listen to your midwife as she can advise you when to stop pushing and start panting or blowing quick short breaths out of your mouth.

The aim of this is to deliver your baby’s head nice and slowly so the skin and muscles in your perineum have time to stretch naturally.

When your baby’s head is crowning, it can feel very intense and you may get the urge to push as hard as you can to get the birth over and done with as quickly as possible. Your midwife will likely advise you to pant - imagine blowing out ten candles one after the other.  This helps to slow down the delivery of the head and give your perineum a little time to stretch naturally.

The position you give birth in can also make a difference. Lying on your back means your body will have to work harder to push your baby out.

Lying on your side or getting onto all fours will reduce the risk of tearing and help your body to deliver your baby naturally without the need for intervention. There is also anecdotal evidence that suggests women may be less likely to tear during a water birth however, the jury is out on this one!  Either way, having your baby in water is a lovely way to give birth so don’t let worries about tearing impact your decision making on this.

Your midwife or doctor will also do what they can to help reduce the risk of a serious tear. This may include placing a warm compress on your perineum while your baby’s head is being delivered.  This is also shown to help reduce tearing and many women report it feeling quite soothing.

Staying as relaxed as you can during the birth can also help reduce the risk of tearing. This may mean having a trusted person supporting you as a birth partner or listening to calming music or a hypnobirthing track.  You may also want to consider signing up to our lovely hypnobirthing course to give you some hints and tips on how to stay as relaxed as possible.

For some women, giving birth at home or in a midwife-led unit, if this is medically appropriate, may help them to feel more relaxed.

Sign up for a free online antenatal class